Meeting Report
Transcultural Psychogeriatrics: An International Symposium Presented in Munich at Aging 2000

Meinhardt S. Tropper, MD, PhD

A symposium dedicated to transcultural psychogeriatrics was presented during IPA's recent Joint Meeting in Munich. The first part of the introductory lecture, Transcultural Psychogeriatrics, paid tribute to Emil Kraepelin, the father of psychiatric nosology, and emphasized that comparative ethnopsychology (volkerpsychologie) and comparative psychiatry were founded by this outstanding psychiatrist, scientist, and educator, who worked so creatively in Munich in the first decades of our century. The lecture emphasized current demographic changes in the world - the increased life span and huge migration waves (from Eastern to Western Europe, Southeast Asia to Australia and North America, Africa towards Europe, etc.); the aging of the "gastarbeiters" in Germany; and the wars in Rwanda, Zaire, Yugoslavia and elsewhere, which bring refugees in their wake. Based on data from a longitudinal comparative study (1974-1997) of 1,614 elderly immigrants from countries of the Former Soviet Union, who are now in Israel, I reported on differences due to cultural diversity in the manifestation of psychopathological symptoms and syndromes in dementia, as well as in depression, anxiety, compliance, service utilization, reactivation of stressful events in the past, and psychosomatic disorders.

As a result of global events, an increased number of psychopathological phenomena in the elderly, considered to be influenced by ethnical-cultural characteristics, have drawn the attention of health professionals as well as ministries and departments of immigration and acculturation in the USA, Canada, Australia, Germany, UK, New Zealand, France, Israel, and other countries. Many elderly communities in large cities become multi-cultural and multi-ethnic. This represents an issue of concern for authorities and medical institutions, as well as a topic of psychogeriatric research.

This field could and should be named transcultural psychogeriatrics. Culture is defined as a social cohort set of meanings, customs, and beliefs, reflected in people's actions, behavior, language, interaction, and shared experiences. Cultural psychiatry is a field concerned with the etiology, symptomatology, diagnosis, treatment, prevention, and prognosis of mental disorders, within a particular culture. As a result transcultural psychogeriatrics represents an expansion of cultural psychiatry towards older age groups, and includes the pertinent symptoms, signs, syndromes and related psychosocial issues, which extend beyond the boundaries of one culture.

Some of the main topics for study in this field would include: the cultural context of behavioral and psychological symptoms of dementia (BPSD), depressive disorders, anxiety, pain syndromes, somatization, communicative aspects of older people's complaints, the relationship between elderly language capacity in the hosting country, and mental health services utilization, transcultural patterns of drug use in the elderly, identical ethnicity and cultural diversity of the elderly in countries of mass immigration, and psychotherapy performed in the elderly patient's native language.

H. Bickel (Germany) presented a lecture on the protective and adverse effects of drug use on cognitive decline in a prospective study of elderly general practice patients in Germany. The essence of the study, which was carried out by him and his colleagues, was to explore associations of use by German elderly of psychotropics and drugs which are claimed to protect against cognitive decline and dementia. The study was based on a stratified random sample drawn from a total of 3,700 patients who attended their GPs during a four-week period. After a mean interval of 27 months, repeated assessments of the whole sample were carried out. The presented findings refer to patients who initially showed no, or only minimal or mild, cognitive impairment, according to the CAMDEX criteria. The conclusions drawn from this naturalistic longitudinal study are: cognition enhancing drugs may have preventive effects on cognitive decline among elderly people, and antidepressive drugs may have the potential to cause additional cognitive impairment.

S. Hazama (Japan) reported on the survival rate of patients with dementia, based on data gathered during 1987-1992 in Okinawa. The study results support previous publications indicating a more favorable prognosis in the Japanese population with Alzheimer's disease, than those with Vascular Dementia (VaD), and also determined a longer life expectancy of women in Okinawa who have the most favorable record in Japan. G.H. Suh (Korea) presented a survey on prevalence and risk factors for AD and VaD in 1,037 elderly in a Korean rural community. Statistically significant factors for AD (age over 85, illiteracy, alcohol use, and family history of dementia) were listed. Statistically significant risk factors for VaD included illiteracy and family history. The survey's results suggest that AD is more prevalent than VaD in Korea.

A. Henry (France), in a lecture on the psychiatric hospital and the old, described the peculiarities and specificity of geropsychiatric services in France, in particular the psychotherapeutic and ethical aspects of the work with the elderly, and the necessity to take into consideration their cultural background.

About the Author

Meinhardt S. Tropper, MD, PhD, directs the Department of Geriatric Psychiatry of the United Meuhedet Health Fund, Bar Ilan University, Tel Aviv, Israel (tel: +972 3 739 4198, fax +972 3 696 1804). He is a former member of IPA's Board of Directors and served with distinction as Chair of IPA's Fifth Congress, held in Rome in 1991.

Reprinted from IPA Bulletin, Volume 16, Number 1